A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13–15 years in 20 low and middle income countries

BACKGROUND This study assessed the prevalence and influence of exposure to pro-tobacco advertisements among adolescents in 20 low and middle income countries (LMICs). METHODS The 2007-2008 Global Youth Tobacco Survey was analyzed for students aged 13-15 years in 20 LMICs. Overall and sex-specific prevalence of exposure to tobacco advertisements in several media, as well as the prevalence of smoking susceptibility (i.e., the lack of a firm commitment among never smokers not to smoke in the future or if offered a cigarette by a friend) were assessed. The variability of the point estimates was assessed using 95% confidence intervals (CI). Logistic regression was used to assess the effect of exposure to multiple (i.e., ≥2) pro-tobacco advertisements on current smoking, adjusting for age and sex (P < 0.05). Data were weighted and analyzed with Stata version 11. RESULTS Overall country-specific prevalence for different advertisement sources ranged as follows: movies/videos (78.4% in Lesotho to 97.8% in Belize); television programs (48.7% in Togo to 91.7% in the Philippines); newspapers/magazines (29.5% in Togo to 89.7% in the Philippines); and outdoor community events (30.6% in Rwanda to 79.4% in the Philippines). The overall proportion of never smokers who were susceptible to cigarette smoking ranged from 3.7% in Sri Lanka to 70.1% in Kyrgyzstan. Exposure to ≥2 sources of pro-tobacco advertisements was associated with significantly increased odds of cigarette smoking among adolescents in several countries including South Africa (adjusted odds ratio, aOR = 4.11; 95% CI:2.26-7.47), Togo (aOR = 3.77; 95% CI:1.27-11.21), the Former Yugoslav Republic of Macedonia (aOR = 1.42; 95% CI:1.01-1.99), Republic of Moldova (aOR = 1.53; 95% CI:1.11-2.12), Belize (aOR = 13.95; 95% CI:1.91-102.02), Panama (aOR = 5.14; 95% CI: 2.37-11.14) and Mongolia (aOR = 1.52; 95% CI:1.19-1.94). CONCLUSION Prevalence of exposure to various pro-tobacco advertisements was high among adolescents in the LMICs surveyed. Enhanced and sustained national efforts are needed to reduce exposure to all forms of tobacco advertising and promotional activities.